Many African governments are formalising their social support systems to fight poverty. This is highly political due to budget constrains and nepotism. How can these governments extend social protection through a more integrated and inclusive system? We looked at two social protection policies: cash transfers to the poor and free social health insurance. In both Ghana and Kenya.We specifically looked at the interaction between the two policies. This multidisciplinary research runs since 2015 and involves researchers and policy makers in Ghana and Kenya. Together we addressed the question: What kind of interaction effects do these social protection policies have on different vulnerable groups in Kenya and Ghana? Do they multiply or on the contrary substitute each other? Moreover: how do these effects feedback into policy reforms in these two different countries? The debate around social protection in Kenya and Ghana has become heavily influenced by the World Bank and other donors since the mid-1980s. The approach changed from a universal risk mitigation towards a minimalistic social safety net. In other words social protection became formalized: narrowly defined demographic, health and income characteristics became the targeting principles of people’s entitlements for social protection. However, we observe big groups of poor falling through the cracks of the new system. Does this mean that these different social
protection policies substitute each other? What we find is that the Interaction effects are scattered and few. Some multiplier effects prevail in the case
of child health, land and livestock ownership of the poor. This is the case for the Livelihood and Empowerment programme in Ghana. In which the poor benefit from free health
insurance. However, the multiplier effects are weakened by programme regulations, implementation failures, and political clientelism. And the village may have a health clinic, but if there are no medicines or staff free health care is an empty shell. In Kenya political clientalism is even more
a problem. And the recent decentralisation of power to lower administrative level has not resolved this problem. On the contrary, it seems to open-up new channels of political clientelism and undoing institutional learning. In both countries we also see that local ‘informal’ institutions like village leaders and community councils collaborate with formal institutions in information collection, dispute settlement and targeting. There we see that institutional learning does take place and trust in government is enhanced. Unfortunately, in Kenya, social protection
reforms have been blocked and sometimes reversed. Because the political debate on the ‘deserving’ and ‘non-deserving poor’ is particularly fierce and inequality is notoriously high.Whereas in Ghana, where extreme poverty has been reduced in recent years, we observe an incremental shift towards programme integration and upscaling. Therefore the debate on social protection
and inclusive development is also influenced by national notions of equality and inequality.